老年肾移植临床分析

目的 探讨老年患肾移植的特点。方法 回顾总结86例老年（大于55岁）肾移植患的临床资料，包括术前基础状况、术前准备、免疫抑制用药以及术后并发症等，并与小于55岁的487例肾移植患作对照。结果 老年患基础情况较差，低蛋白血症、贫血较对照组严重，差异有显性意义；排斥反应差异无显意义（P＞0．05）；老年组环孢素A用量较少，血药浓度较高，肝功能损害发生率较高，与对照组差异有显性意义（P＜0．05）；老年组1、3年人／肾存活率为81．4％／75．7％，72．7％／66．3％，与对照组（分别88．3％／83．2％、78．3％／72．4％）无显差异（P＞0．05）。结论 老年肾移植患存在全身情况较差、感染和心血管等并发症发生率较高的风险，但只要无手术禁忌症，术前准备充分、术后用药合理、积极防治并发症，其移植亦效果满意。     

荧光定量PCR法检测生殖器疱疹病毒感染患者的结果及分析

目的：了解重庆地区疑有单纯疱疹病毒（HSV）感染患者的感染情况。方法：用荧光定量PCR法对422例疑有HSV感染的门诊患者进行检测。结果：（1）3个年龄段患者，即≤25岁，＞25岁并≤35岁，＞35岁的阳性率分别为27．93％（31／111）、23．65％（48／203）、15．74％（17／108），0．05＜P＜0．1，无差异。（2）男性患者和女性患者的阳性率分别为29．5％（41／139）和19．43％（55／238），P＜0．05，相差显著。（3）妇科、泌尿科、皮肤科就诊患者的阳性率分别为18．14％（41／226）、26．44％（23／87）、29．36％（32／109），P＜0．05，相差显著。结论：（1）重庆地区HSV感染率在男性患者和低龄人群（≤25岁）中发病率较高。（2）皮肤科患者的阳性率较其他两个科室为高。说明取标本的采取集部位十分重要。（3）FQ－PCR特异性高，灵敏度强，操作简单，时间短，结果客观准确，特别适宜于门诊患者快速检测诊断的需要。     

急性胰腺炎合并肮脏损害

目的：探讨急性胰腺炎合并肝脏损害对胰腺炎的病因、发展及预后的临床意义。方法：将182例急性胰腺炎患分为轻症急性胰腺炎（MAP）和重症急性胰腺炎（SAP）两组，检查肝功能。结果：MAP组合并肝损害17．7％（25／41），SAP组为100％（41／41）。谷丙转氨酶升高及白蛋白下降，两组有显性差异（P＜0．05）。合并肝损害患的同时合并消化道出血，SAP43．9％（18／41），MAP为16％（4／25）。（P＜0．05）。病因按有胆系疾病史和有饮酒及暴饮暴食分为两组，两组各项指标差异均无显性（P＞0．05）。＞55岁合并肝损害54．2％（39／72）；≤55岁24．5％（27／110）。（P＜0．01）。结论：肝脏损害程度与急性胰腺炎程度呈正相关。MAP合并肝脏损害预后不良。肝功能损害与急性胰腺炎病因无直接相关性。年龄对急性胰腺炎的发展及预后有较密切的关系。     

咸宁市齿龈内阿米巴感染状况与口腔疾病关系分析

目的：了解咸宁市齿龈内阿米巴感染状况,探讨与口腔疾病之间的关系。方法随机选择湖北科技学院附属第二医院口腔科门诊病人200人,湖北科技学院1～3年级大学生300人进行问卷调查,调查内容包括性别、年龄、住址、刷牙习惯、使用牙膏类型、嚼口香糖习惯、口腔疾病史等。以消毒牙签取受检者口腔齿龈上或病灶表面附着物,生理盐水直接涂片,光学显微镜下观察。结果500例受检者齿龈内阿米巴感染率为36.2％,其中男、女性齿龈内阿米巴感染率分别为37．4％和35．1％（ P＞0．05）;齿龈内阿米巴感染率随年龄增长而逐渐升高（P＜0．05）;城市和农村人群齿龈内阿米巴感染率分别为30．4％和444．％（P＜0．01）;经常刷牙者齿龈内阿米巴感染率低于不经常刷牙者（P＜0．01）;使用普通牙膏者齿龈内阿米巴感染率低于使用药物牙膏者（P＜0.05）;经常嚼口香糖者齿龈内阿米巴感染率低于不经常嚼口香糖者（P＜0．05）;有口腔疾病的患者齿龈内阿米巴感染率高于健康者（P＜0．01）;其中牙周炎患者齿龈内阿米巴感染率最高（P＜0．05）。结论齿龈内阿米巴感染与口腔疾病和口腔卫生状况密切相关。     

科素亚对老年高血压患者血清尿酸水平和血压的影响

目的：观察利素亚对老年高血压患血清尿酸水平和血压的影响。方法：62例轻中度老年高血压患随机分成2组，科素亚组（n＝31）给予科素亚治疗，卡托普利组（n＝31）给予卡托普利治疗，疗程均为4周。治疗前后，两组分别进行血清尿酸值测定和血压测定。结果：血清尿酸水平科素亚组治疗前后比较有显性差异（P＜0．01），卡托普利组无显性差异（P＞0．05）。血压下降的幅度两组无显性差异（P＞0．05）。结论：科素亚能降低血清尿酸水平和血压，可用于治疗血清尿酸水平升高的老年高血压病。     

ⅢA期非小细胞肺癌手术前后化疗比较

目的：通过病例对比，研究手术前新辅助化疗及手术化疗对改善ⅢA期非小细胞肺癌患生存率的影响。方法：ⅢA期非小细胞肺癌患62例A组（32例）术前给予新辅助化疗，B组（30例）术后行辅助化疗，结果：中位生存时间A组29mo,B组27mo,A组1a生存率81．2％（26／32），2a生存率46．8％（15／32），3a生存率37．5％（12／32）；B组分别为83．3％（25／30），46．6％（14／30）和33．3％（10／30），A、B组相应指标比较，均无显性差异（P＞0．05），结论：术前新辅助化疗并不能改善ⅢA期非小细胞肺癌患术后1，2和3a生存率。     

乙型肝炎患者血清的自身抗体测定和临床分析

目的 对192例乙型肝炎（HB）患进行自身免疫抗体的测定并作临床分析。方法 应用间接免疫荧光法，以生物薄片马赛克技术制备的覆盖Hep-2细胞，猴肝和心肌，鼠肝、心、肾和胃六种组织细胞为抗原与待检血清结合后，加入荧光素标记抗人免疫球蛋白，根据荧光反应模式判定结果。结果 （1）HB患自身抗体的检出率分别为ANA25．00％，AMA6．25％，SMA11．46％，CS10．94％；（2）HBV DNA阳性与HBV DNA阴性患自身抗休检出率无明显差别（P＞0．05）；（3）ALT较高患检出的自身抗体滴度较高，但ALT的高低与自身抗体ANA的滴度之间差异无显性意义（P＞0．05）。部分阳性病例随访1－6月表明：随着ALT的恢复，自身抗体滴度呈下降或阴转趋势。结论 在乙型肝炎病毒感染过程中机体存在自身免疫反应，自身抗体的消长与乙肝病毒复制状况及转氨酶的升降无明显相关性。     

NP方案与MVP方案治疗晚期非小细胞肺癌疗效比较

目的：比较NP方案与MVP方案对晚期非小细胞肺癌（NSCLC）的治疗效果。方法：86例患分别用NP（NVB 25mg/m^2,iv,d1.8;DDP50mg/日，iv,d1-3）或MVP（MMC6－8mg/m^2,iv,d1;vds3mg/m^2,iv,d1.8;DDP50mg/日，iv,d1-3)方案治疗1。结果：NP组总有效率47．5％（19／40），CR3例，PR16例；MVP组总有效率43．5％（20／46），无CR，PR20例。两组总有效率无显性差异（P＞0．05），分析影响疗效的因素发现，病期早较病期晚好（P＜0．05）初治较复治好，但统计学无显性差异（P＞0．05）。骨髓抑制为限制性反应，白细胞下降分别为100％和91．3％，Ⅲ度以上下降分别为55％和24％。注射局部毒性反应在NP组72．2％，Ⅲ度8．3％。MVP组无此反应。结论：对晚期非小细胞肺癌，选用NP方案和MVP方案疗效均较好且相似，值得临床采用。     

鱼腥草注射液治疗单纯疱疹性角膜炎疗效观察

目的：观察鱼腥草注射液对单纯疱疹性角膜炎的疗效，方法：将120例患随机分为治疗组和对照组各60例，治疗组采用西药和鱼腥草注射液治疗，对照组采用西药治疗。结果：治疗组治愈率为93．24％，有效率为98．6％；对照组治愈率为73．53％，有效率为85．3％，差异有显性（P＜0．05），两组治愈时间比较，差异有非常显性（P＜0．001），治疗组明显短于对照组，两组治疗前后视力差值比较，差异有显性（P＜0．05），治疗组视力提高幅度大于对照组。结论：使用西药与鱼腥草注射治疗单纯疱疹性角膜炎，见效快，复发率低。     

胶囊内镜对不明原因消化道出血患者临床诊断价值

目的：探讨胶囊内镜对不明原因消化道出血的诊断价值。方法：应用M2A胶囊内镜检查系统对90例经胃镜、肠镜检查阴性的消化道出血患者进行检查。结果：90例不明原因消化道出血患者共进行92次胶囊内镜检查，检查成功率为94．57％（87／92），其中急性大量出血组检查成功率为84．0％（21／25），慢性显性出血组检查成功率为98．51％（66／67），两者经χ^2检验有显著性差异（P〈0．05）。在检查成功的患者中，胶囊内镜的病变检出率为85．06％，假阴性率17．24％。急性大量出血组病变检出率80．95%，假阴性率23．81％；慢性显性出血组病变检出率86．36%，假阴性率15．15％，经χ^2检验均无显著性差异（P〉0．05）。结论：胶囊内镜对不明原因消化道出血有较高的检出率，可以作为小肠出血的首选检查方法。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.